Clin Endosc.  2023 Jul;56(4):521-526. 10.5946/ce.2021.276.

Portal cavernography during endoscopic retrograde cholangiopancreatography: from bilhemia to hemobilia

• Yared RA
• Gkolfakis P
• Lemmers A
• Huberty V
• Degrez T
• Devière J
• Blero D

• KMID: 2544575
• DOI: http://doi.org/10.5946/ce.2021.276

Abstract

Portobiliary fistulas are rare but may lead to life-threatening complications. Biliary plastic stent-induced portobiliary fistulas during endoscopic retrograde cholangiopancreatography have been described. Herein, we present a case of portal cavernography and recurrent hemobilia after endoscopic retrograde cholangiopancreatography in which a portobiliary fistula was detected in a patient with portal biliopathy. This likely indicates a change in clinical presentation (from bilhemia to hemobilia) after biliary drainage that was successfully treated by placement of a fully covered, self-expandable metallic stent.

Keyword

Endoscopic retrograde cholangiopancreatography; Hemobilia; Portobiliary fistula; Portal cavernography

Figure

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  Fig. 1. (A) T2-weighted image (axial plane) depicting compression of the common bile duct between two venous structures (arrows). (B) T2-weighted image (coronal plane) showing a vessel as a low signal tubular structure (arrow) parallel to the common bile duct.

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  Fig. 2. Endoscopic image showing active bleeding from the papillary orifice (hemobilia).

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  Fig. 3. (A, B) Cholangiogram showing opacification of a venous structure compatible with the known cavernoma (black arrows) and contrast dye in a venous branch parallel to the bile duct (long white arrow) with possible orifice of portobiliary fistula (short white arrow).

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  Fig. 4. Radiography showing the fully covered self-expandable metal stent deployed in the main bile duct.

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  Fig. 5. (A) Radiography showing opacification of the common bile duct with no residual fistula during the endoscopic retrograde cholangiopancreatography performed to replace the initially placed fully covered self-expandable metal stent. (B) Radiography showing opacification of the common bile duct with no residual fistula or stenosis after definitive removal of the fully covered self-expandable metal stent.

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